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At least 199 records · Page 11Linked to original sources
PubMed1998

The importance of developing an informatics framework for mental health.

Though mental health services are important in human terms, and account for a tenth of health expenditure, they are not well served in informatics developments. There are no specific mental health components in the European Union's health telematics programmes, and there is similar under-representation in national programmes. Yet telematics has much to offer mental health services and their management, and can address directly current service anxieties. Telematics concepts which could benefit mental health include integrated, multi-disciplinary records, real-time multi-site record access, and structured programmes to plan, schedule, and monitor care delivery. The power of information systems to sort data, and to represent them graphically, can sift like data items from complex records, and can present them in displays which highlight their significance. Above all, quality of care can be enhanced by monitoring, and by improved outcome measurement. However, a planned programme of research and development is needed, to relate and adjust current health informatics techniques to the special attributes of mental health. The World Health Organisation has identified the potential of such a programme, but greater vision and commitment is needed at policy level if mental health services and patients are to receive the benefits from health informatics which are available to the physically ill.

Abstracting and Indexing↗
PubMed1997

The development of an approach to evaluate NHS manager's competence in medical informatics.

This paper describes the research and development of Checkpoint, a self-assessment instrument. It outlines how the instrument has helped managers in the NHS identify their strengths and weaknesses with respect to their management and use of informatics. The paper presents trends and feedback from the use of Checkpoint and the implications for future education and training of managers in the NHS.

Administrative Personnel↗
PubMed2003

Concept of a PACS and imaging informatics-based server for radiation therapy.

Radiation Therapy (RT) is an image-based treatment. It requires images from projection X-rays, computed tomography, magnetic resonance, positron emission tomography, Linear Accelerator for tumor localization, treatment planning and verification of treatment plans. During the treatment process, patient's images are transmitted to every necessary station in the RT department. However, images of the same patient are generally scattered and there is no permanent home base for them due to the nature and traditional organization of the RT department. The advance in diagnostic picture archiving and communication system and the establishment of RT DICOM Standard provide an opportunity to define and design an RT server as a means to organize RT images and related data. This paper describes the RT workflow and the concept of the DICOM RT server. An example of RT treatment of nasopharyngeal carcinoma based on the RT server concept is given.

Diagnostic Imaging↗
PubMed2000

A computerized guideline for pressure ulcer prevention.

This paper illustrates the implementation of a computerized guideline for pressure ulcer prevention. In particular, it describes the aspects related to the site-specification of a guideline delivered by the Agency for Health Care Policy Research (AHCPR), to its integration with the electronic patient record, and to its implementation within the clinical routine. The primary goal of the system is both to facilitate nurses assessing the risk of ulcer development, and to manage patients at risk by producing daily prevention work-plans. Concerning this functionality, particular attention has been paid to manage nurse's non-compliance with the guideline suggestions and to collect data for evaluating the guideline impact. Moreover, since it is well known that nurses are often over-loaded, the human computer interaction has been studied in such a way to optimise the time spent for data input. An additional functionality of the system is the novice nurses' education - they can browse a graphical representation of the guideline, asking details about the different tasks, and they can simulate patients to obtain real-time advice. The educational tool is written in Java and it is based on a representation of the guideline as a relational database. A preliminary evaluation of the system has been performed and the results are presented on the management of about 40 patients.

Decision Support Systems, Clinical↗
PubMed2002

Use cases and DEMO: aligning functional features of ICT-infrastructure to business processes.

OBJECTIVES: The proper alignment of functional features of the ICT-infrastructure to business processes is a major challenge in health care organisations. This alignment takes into account that the organisational structure not only shapes the ICT-infrastructure, but that the inverse also holds. To solve the alignment problem, relevant features of the ICT-infrastructure should be derived from the organisational structure and the influence of this envisaged ICT to the work practices should be pointed out. The objective of our study was to develop a method to solve this alignment problem. METHODS: In a previous study we demonstrated the appropriateness of the business process modelling methodology Dynamic Essential Modelling of Organizations (DEMO). A proven and widely used modelling language for expressing functional features is Unified Modelling Language (UML). In the context of a specific case study at the University Medical Centre Utrecht in the Netherlands we investigated if the combined use of DEMO and UML could solve the alignment problem. RESULTS AND CONCLUSION: The study demonstrated that the DEMO models were suited as a starting point in deriving system functionality by using the use case concept of UML. Further, the case study demonstrated that in using this approach for the alignment problem, insight is gained into the mutual influence of ICT-infrastructure and organisation structure: (a) specification of independent, re-usable components-as a set of related functionalities-is realised, and (b) a helpful representation of the current and future work practice is provided for in relation to the envisaged ICT support.

Health Status↗
PubMed2002

CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved.

This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review places particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups.

Aged↗
PubMed2002

Adaptive user interface customization through browsing knowledge capitalization.

Hypermedia data browsing is a mean for improving information access. However, the overload and the heterogeneity of medical information, as well as the multitude of possible navigational paths, turn the consultation of data into a difficult task. We present in this paper a solution for the development of adaptive user interfaces in a hypermedia data browsing environment. It is based on the capitalization of the users knowledge in the decision-making process, expressed in terms of navigational paths and of data presentation modes that are customized to the user's preferences and practice. This capitalization offers the user a way to automatically store and reuse the experience accumulated in browsing through patient records. We illustrate our approach with the implementation of HEMA, a clinical workstation prototype that we have specialized for the cardiology domain.

Artificial Intelligence↗
PubMed2003

Implementing computerized physician order entry: the importance of special people.

OBJECTIVE: To articulate important lessons learned during a study to identify success factors for implementing computerized physician order entry (CPOE) in inpatient and outpatient settings. DESIGN: Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. RESULTS: The theme we call Special People is explored here in detail. A taxonomy of types of Special People includes administrative leaders, clinical leaders (champions, opinion leaders, and curmudgeons), and bridgers or support staff who interface directly with users. CONCLUSION: The recognition and nurturing of Special People should be among the highest priorities of those implementing computerized physician order entry. Their education and training must be a goal of teaching programs in health administration and medical informatics.

Focus Groups↗
PubMedDate not supplied

Federated healthcare record server--the Synapses paradigm.

The delivery of healthcare relies on the sharing of patient information between those who are providing for the care of the patient and this information is increasingly being expressed in terms of a 'record'. Further, it is desirable that these records are available in electronic form as Electronic HealthCare Records. As it is likely that patient records or parts of records will be stored in many different information systems and in the form of disparate record architectures, uniform access to patient records would be problematic. This paper presents an overview of the Synapses computing environment in which a Federated Healthcare Record Server provides uniform access to patient information stored in connected heterogeneous autonomous information systems and other Synapses servers. The Synapses record architecture is based on the architecture proposed by the Technical Committee 251 of the European Committee for Standardisation and the interfaces to the Synapses server are specified in the ISO standard Interface Definition Language. Synapses is a pan-European project involving a number of hospitals, software companies, universities and research institutes and is partly funded by the EU Health Telematics Programme. The overview is described in terms of the Open Distributed Processing Reference Model.

Computer Communication Networks↗
PubMed1999

The contextual nature of medical information.

Successful design of information systems in health care starts with a thorough understanding of the practices in which the systems are to function. In this paper, we discuss the nature of 'medical information' from a sociological perspective. We focus on the (im)possibilities of the utilization of primary health care data for secondary purposes such as research and administration. In much of the literature on EPRs, this secondary utilization is only seen to depend on the question whether the IT connections are in place. It is then simply a matter of selecting which information to transport and to where. In this article, we argue that this view of medical information is mistaken. Information should be conceptualized as always entangled with the context of its production. The disentangling of information from its production context is possible, but that entails work. We propose the following 'law of medical information': the further information has to be able to circulate (i.e. the more diverse contexts it has to be usable in), the more work is required to disentangle the information from the context of its production. The question that then becomes pertinent is; who has to do this work, and who reaps the benefits?

Decision Support Techniques↗
PubMed2002

Electronic case-report forms of symptoms and impairments of peripheral neuropathy.

BACKGROUND AND OBJECTIVE: For the conduct of controlled clinical trials, epidemiologic surveys or even of medical practice of varieties of peripheral neuropathy, the usefulness, error rate and cost-effectiveness of scannable case-report forms has not been studied. MATERIALS AND METHODS: The overall performance, the frequency of the problems identified and corrected, and the time saved from use of a standard paper case report form was evaluated in multicenter treatment trials, single center epidemiologic surveys and in our neurologic practice. The paper case report form (Clinical Neuropathy Assessment [CNA]) for pen entry at study medical centers for patient, disease and demographic information (Lower Limb Function [LLF] and Neuropathy Impairment Score [NIS]) can be faxed to a core Reading and Quality Assurance Center where the form and data is electronically and interactively evaluated and corrected, if needed, by participating medical centers before electronic entry into database. OBSERVATIONS AND CONCLUSIONS: 1) The approach provides a standard, scannable paper case report form for pen entry of neuropathy symptoms, impairments and disability at the bedside or in the office which is retained as a source document at the participating medical center but a facsimile can be transferred instantaneously, its data can be programmed, interactively evaluated, modified and stored while maintaining an audit trail; 2) it allowed efficient and accurate reading, transfer, analysis, and storage of data of more than 15,000 forms used in multicenter trials; 3) in 500 consecutive CNA evaluations, software programs identified and facilitated interactive corrections of omissions, discrepancies, and disease and study inconsistencies, introducing only a few readily identified and corrected entry errors; and 4) use of programmed, as compared to non-programmed assessment, was more accurate than double keyboard entry of data and was approximately five times faster.

Canada↗
PubMed2002

A study of the medical record interface to natural language processing.

The information about a patient tends to be handled more on a computer system. However, it is not sufficiently rational enough because of the fundamental difference between man and a computer. Up to now, man has treated information using a natural language. Therefore, if it can be applied to handle medical information electrically, that will become more rational. For this reason, we developed a new classification method that interfaces a computer with the human being, using a natural language. This method was named as a situation-oriented medical record, and this depicts changes in a situation by the case frame from a viewpoint of man's cognition. Moreover, the medical communication by a natural language, which is currently used when a patient changes a hospital, was analyzed in order to confirm the validity of this method. In addition, we developed a prototype system that allows computers to implement this kind of communication.

Humans↗
PubMedDate not supplied

[Computer-assisted documentation and therapy planning in pediatric oncology--introduction of a nationwide solution].

In Pediatric Oncology in Germany, 90% of the patients are treated according to multicenter clinical trials, which means an enormous effort for documentation in the participating clinics. In order to enable multiple use of data for patient records as well as for clinical trials a computer-based documentation system for pediatric oncology (DOSPO) is being developed, which can be used nationwide. DOSPO currently comprises a minimum basic data set, which represents the common core of all multicenter trials and which has been approved by the German Society for Pediatric Oncology and Hematology (GPOH). It is intended to enhance the documentation by specific items of each clinical trial. Functions for computer-aided chemotherapy planning and medical report writing have already been implemented in the documentation system. Various centers in Germany are currently validating the system in routine use.

Child↗
PubMed1987

[Follow-up care in colorectal adenoma].

From 1980 to 1985, 319 adenomatous colorectal polyps were removed in 297 patients. All patients were entered into a computerized follow-up programme with yearly follow-up. The recommended follow-up was rejected by 58 patients (22.1%). 93 new adenomatous polyps were found in the course of the follow-up in 53 patients (35.8%), five of them histologically invasive carcinomas. The proportion of carcinomas was lowered from 10.6% at first examination to 5.4% in the follow-up period. Size of polyp correlated significantly with carcinomatous change. Size of the adenomas removed at follow-up was markedly smaller than that removed at first examination (69.4% smaller than 1 cm compared with 44.2% at follow-up). In six patients with early invasive carcinoma, further resections were undertaken, while in six others only the polyps were removed. But local recurrences occurred in both groups. Regular follow-up after polypectomy of colorectal adenoma is thus essential.

Adolescent↗